Evidence-Based Medicine: A New Discipline?

Articles in the medical literature that use "evidence-based" methodology have been increasing significantly during the past few years. This technique for developing clinical guidelines, evaluating outcomes, and validating current practice has been touted as the latest Holy Grail in every medical specialty publication.1 Is evidence-based medicine really anything other than a diligent and critical use of the medical literature to evaluate how we practice medicine? It is not a new research technique. Perhaps our more careful examination of the costs of health care related to managed care's effect has initiated this process. Randomized clinical trials, cohort studies, retrospective reviews, and even meta-analyses have been the construct of our medical literature, including the Archives of Surgery, for decades. The more careful collection, interpretation, and subjective evaluation of prior studies published in peer-reviewed journals are necessary processes that physicians must perform. When we evaluate what medications we prescribe, what procedures we perform, or how we allocate our health care resources, our prudent interpretation of carefully performed clinical research will allow us to justify the adverse effects, complications, or expense. Evidence-based medicine is not new. It just represents the further evolution of today's medical practice and its effect on our methods of scientific justification.